This story originally appeared in IHI's 2008 Annual Progress Report.
Each year, more than a million Americans have a heart attack — also known as an acute myocardial infarction, or AMI. A third of them don’t survive. Paul Corn is one of the lucky ones who got the right care at the right time.
A pharmacist in Clemson, South Carolina, Corn recognized the symptoms after a morning of yard work, and went to a nearby urgent care center right away. “I didn’t want to be a statistic,” he says. From there he was immediately transported by ambulance to AnMed Health Medical Center in Anderson, South Carolina.
Optimal AMI care includes a specific series of steps and components, and timing is key. Ideally, patients who require coronary angioplasty to open the blocked artery should have the procedures within 90 minutes of their arrival at the hospital.
Like a relay race, this requires carefully timed handoffs from the triage area to the emergency department (ED) physician and finally to the catheterization lab. When AnMed staff analyzed their process, they found several ways to improve, says Leigh Miller, RN, MSN, Director of Clinical Outcomes.
Steps were eliminated, such as waiting for the patient’s primary care doctor to evaluate the patient and call the cardiologist; now the ED doctor does that. Preprinted orders were overhauled and their use reinforced. Schedules were rearranged based on the distance cath lab staff need to travel from home in an emergency. “We even changed the rules about where staff can park,” says Miller.
For Paul Corn, “everyone was in the right place at the right time. My care couldn’t have gone any better. I was back at work in three weeks.” And his is not a unique outcome. While in 2005 only 37.5 percent of appropriate patients received their angioplasty within 90 minutes, by the end of 2006, that number had risen to 96 percent. In 2005, mortality for AMI patients was 13 percent; in 2006, that figure was below 5 percent.